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[Pressure] TheWallofSleep's Therapy Thread
#81
RE: Help Calibrating APAP Pressure
I would consider this approach, as any BPAP in light of you being predominant Central will be utter chaos if anywhere similar to my experience. I would point out your CA and Hypopnea on the diagnostic test. Then ask to be considered to move on to ASV. If they want more evidence, you need to be open to doing an ASV titration.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#82
RE: Help Calibrating APAP Pressure
You are probably right. I am certainly not against getting another titration, but I would like to avoid it. They are expensive and it adds on another 2-3 months time easy when considering the appointment is always booked 2-3 weeks out, then the study, then the interpretation, then the follow up, and so forth. I do know I may not have a choice.

I do have a very specific question for you guys that see event flag charts all day long. I have been reading some literature on sleep disorders, particularly the physiology of sleep, OSA, CSA, etc., to the best of my ability. I can definitely see why the doctors think the way that they do, it is written in the textbooks themselves. CSA is diagnosed if events occur 5 or more times per hour and if they constitute 50% or more of the total events. Everyone knows this, it is in the Oxford Textbook of Sleep Disorders among other similar sources. But something I cannot find a lot of information on is the grouping of central events throughout the night. Is there a correlation between some individuals and grouping of events or lack thereof? My CSA index is always fairly low, however, I seem to see them appear in clusters (see attachment below). I am not a doctor, but I would assume that several events one after the other would push you over the arousal threshold for most stages of sleep, explaining why someone could have less than 5 per hour, but still be affected. I may have a normal level of events, but I have them in abnormal succession. This could also reflect upon AHI being a poor metric in general as it anticipates regularly intervaled events. I would love some thoughts on that.

Edit: I should specify that I do understand the complexity of the question. It would appear the "why" has something to do with the metabolic control system, but that is above my paygrade. I am just curious if there is a general observable trend.


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#83
RE: Help Calibrating APAP Pressure
That is a 15 minute view, cut it to 10 minutes.
Your breathing from 11:19 to 11:22 is showing some slight signs of CO2-induced breathing, The breathing around the CA events themselves is looking more idiopathic (unknown cause), which is why I want to see a 10-minute view and see the breaths in a little more detail.

What happens at PS=2? what do the centrals look like there? They should be decreased and possibly feel better for you.

You are not typical, so as an experiment try PS=6 and see what happens.

With ANY change do note which settings feel better for you?
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#84
RE: Help Calibrating APAP Pressure
Will do. I have been trying to track the changes very closely, particularly how my mornings change and how my afternoons change. I am trying not to rush changes, but I do want to change the PS to see what happens, in both directions.
Here is a closeup of those centrals.
Thank you.

Edit: I will also attach two very closeups in case that is helpful.


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#85
RE: Help Calibrating APAP Pressure
Those do not look like CO2-induced Centrals. They lack the gradual lead into apnea AND the gradual increase following the event. I will not second guess the machine, so I will call the Mixed Apnea, the FOT saying they are central and the appearance indicating obstructive. Thus my call od idiopathic.

If they are CO2-based you should see a reduction in CA events when PS is reduced and an increase when PS in increased.
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#86
RE: Help Calibrating APAP Pressure
Thank you.
I will try lowering PS=2 first. I'm assuming leave the IPAP alone, and just raise the EPAP by 2, correct? If I edit PS itself, it just limits the IPAP by 2.
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#87
RE: Help Calibrating APAP Pressure
Don't change EPAP Min
Change IPAP max to accommodate the higher PS Normally in Auto mode we allow room for the machine to 'roam'.

My max (VAuto) is set to the machine Max, but it never goes anywhere near there. In some cases dealing with CA we have to tightly limit the range, but not normally.
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#88
RE: Help Calibrating APAP Pressure
Noted. Thank you very much.
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#89
RE: Help Calibrating APAP Pressure
Thought I'd drop by and simply comment the suggestions by Dave and Gideon look very good. The PSG study clearly points to a central apnea and hypopnea problem, and I have no doubt ASV would quickly resolve this. There is reluctance on the part of the medical community to actually diagnose what they clearly must see, but eventually they either have to acknowledge failure on CPAP and BPAP and progress to ASV. If not, then the sad fact many ASV users in the U.S. seem to finally force the issue by demonstrating ASV efficacy by self-treating to produce the undeniable evidence. On your current track (typical for idiopathic CA) you are heading back to CPAP with minimal if any pressure support. I'm fairly certain you will find this produces the predictable result that central apnea with CPAP and BPAP is consistently inconsistent and does not really solve the problems with fatigue and other impacts of sleep disordered breathing.
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#90
RE: Help Calibrating APAP Pressure
just a reminder: don't discount the significance of 8.9 plm arousals hour in your sleep test. an arousal every 6.7 minutes will wear you down and could be the source of your centrals. I think you mentioned taking gabapentin; I'm using ropinirole which has substantially reduced my plm but even with treatment plm still causes me multiple arousals and several mask off full awakenings every night. while you would no doubt benefit from asv, no machine or pressure setting will produce the restful sleep you want if plm is still present.
  Shy   I have no particular qualifications or expertise with respect to the apnea/cpap/sleep related content of my posts beyond my own user experiences and what I've learned from others on this site. Each of us bears the burden of evaluating the validity and applicability of what we read here before acting on it.  
 
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